Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BERKSHIRE MEDICAL CENTER INC
Employer identification number
04-2791396
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BERKSHIRE MEDICAL CENTER INC
Employer identification number
04-2791396
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
BERKSHIRE MEDICAL CENTER, INC. RELIES ON BHS MANAGEMENT SERVICES, INC. TO PROVIDE MANAGEMENT AND SUPPORT SERVICES FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, VP GENERAL COUNSEL, AND VP OF HUMAN RESOURCES .
FORM 990, PART VI, SECTION A, LINE 6
BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER OF BERKSHIRE MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF TRUSTEES IS COMPOSED OF THE INCUMBENT MEMBERS OF THE BOARD OF TRUSTEES OF BERKSHIRE HEALTH SYSTEMS, INC.
FORM 990, PART VI, SECTION B, LINE 11
BHS WILL MAKE THE FORMS 990 FOR BHS AND AFFILIATES AVAILABLE TO THE MEMBERS OF THE RESPECTIVE GOVERNING BODIES FOR THEIR REVIEW BY (A) SENDING COPIES TO THEM PHYSICALLY OR ELECTRONICALLY, OR (B) NOTIFYING THE MEMBERS THAT THE FORMS 990 CAN BE ACCESSED BY A SECURE WEB-BASED FOLDER BEFORE THEY ARE FILED WITH THE IRS. IN ADDITION, BHS MANAGEMENT WILL REVIEW THE FORMS 990 WITH THE BHS FINANCE COMMITTEE AND ADDRESS QUESTIONS AND COMMENTS COVERING KEY ELEMENTS OF THE FORMS 990 THAT ARE OF CONCERN TO ALL OF THE FORMS 990, AND ANY SIGNIFICANT ELEMENTS THAT ARE PECULIAR TO ONE OR MORE OF THE AFFILIATES' FORMS 990.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION ENFORCES AND MONITORS ITS CONFLICT OF INTEREST POLICY BY REQUIRING ALL MEMBERS OF THE GOVERNING BODY AND SENIOR MANAGEMENT TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST (A) ANNUALLY AND (B) AS POTENTIAL CONFLICTS ARISE. SENIOR EMPLOYEES ARE NOT PERMITTED TO HAVE MATERIAL CONFLICTS OF INTEREST AND MEMBERS OF THE GOVERNING BODY ARE TO ABSTAIN FROM ACTION THAT MAY BE INFLUENCED BY THEIR CONFLICT OR POTENTIAL CONFLICT BY (A) NOT VOTING OR (B) NOT VOTING AND LEAVING THE ROOM OR (C) LEAVING THE GOVERNING BODY AS DETERMINED BY THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED AND ESTABLISHED AT LEAST BIANNUALLY BY THE INDEPENDENT, VOLUNTEER, BHS GOVERNING BODY, BASED ON PERFORMANCE REVIEWS AND COMPARISON TO INDEPENDENTLY ESTABLISHED, REGIONALLY APPROPRIATE BENCHMARKS FOR SIMILAR POSITIONS IN SIMILARLY SIZED HEALTHCARE ORGANIZATIONS, AS VERIFIED BY INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS SET IN ACCORDANCE WITH GOVERNING BODY-ESTABLISHED PRINCIPLES BASED ON COMPARABLE BENCHMARK IDENTIFIED BY SUCH INDEPENDENT CONSULTANTS. IN THE REPORTING YEAR, THE GOVERNING BODY TARGETED TOTAL COMPENSATION FOR MANAGEMENT EMPLOYEES AT THE 50TH PERCENTILE OF APPROPRIATE BENCHMARKS. THE ORGANIZATION FOLLOWED THIS PROCESS FOR YEAR ENDED 9/30/12.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNANCE DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT THE OFFICE OF (A) THE CHIEF FINANCIAL OFFICER AND (B) THE VICE PRESIDENT AND GENERAL COUNSEL AT 725 NORTH STREET, PITTSFIELD MA 01201.
AVERAGE HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990 SCHEDULE J
BRIAN T BURKE, MD FAIRVIEW HOSPITAL - 48 HOURS/WEEK
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 18,959,616. ASSETS RELEASED FROM RESTRICTIONS FOR OPERATING PURPOSES -93,336. TOTAL TO FORM 990, PART XI, LINE 5: 18,866,280.
RURAL FLOOR PROVISION IMPACT ON REVENUE:
FORM 990, PART I, LINE 9
IN FISCAL YEAR 2012, BERKSHIRE MEDICAL CENTER AND ALMOST ALL OTHER MASSACHUSETTS HOSPITALS EXPERIENCED AN UNUSUAL AND LIKELY TEMPORARY INCREASE IN REIMBURSEMENT FROM THE MEDICARE PROGRAM DUE TO THE MANNER IN WHICH THE MEDICARE PROGRAM APPLIED ONE ELEMENT OF ITS REIMBURSEMENT CALCULATION. FOR MANY YEARS, THE APPLICATION OF THIS SAME ELEMENT OF THE REIMBURSEMENT CALCULATION WORKED TO THE DETRIMENT OF MASSACHUSETTS HOSPITALS, INCLUDING BERKSHIRE MEDICAL CENTER. THE HOSPITAL IS NOT EXPECTING THAT THIS TEMPORARY, POSITIVE ADJUSTMENT WILL CONTINUE. THE VALUE OF THE RURAL FLOOR PROVISION TO BMC IN FY 2012 WAS $16.3 MILLION.
SCHEDULE H, PART VI, LINE 4
CHRONIC DISEASE: HYPERTENSION *IN WORKSITES WITH ACTIVE WELLNESS PROGRAMS (> 220 EMPLOYEES), THE PERCENTAGE OF EMPLOYEES WITH HTN IS APPROXIMATELY 7%. *36% OF EMPLOYEES HAVE PRE-HYPERTENSION NON-WORKING POPULATIONS WITH LIMITED ACCESS TO CARE (HOMELESS, LOW SOCIOECONOMIC, MENTAL HEALTH CONDITIONS AND SUBSTANCE ABUSE) SHARE A DISPROPORTIONATE BURDEN OF RISK AS EVIDENCED BY DATA FROM THE BHS COMMUNITY HEALTH VAN: 18% (N=649) OF POPULATION HAVE BP > 140/90 OF THOSE WITH HBP 336,(51%) ARE ON MEDS AND NOT CONTROLLED -UNDERTREATED OF THOSE WITH HBP, 313 (48%) ARE NOT ON MEDS - NOT TREATED 1,161 PATIENTS HAVE PREHTN AND MORE THAN 30% WILL GO ON TO DEVELOP HBP AND REQUIRED RX- PREVENTION RISK FACTOR PREVALENCE IN VULNERABLE POPULATION OF 142 PEOPLE: HEALTH SCREENING TYPE (N=142) TOTAL# % TOTAL CHOLESTEROL (>240) HIGH 10 7% TOTAL CHOLESTEROL (200-239) BORDERLINE 30 21% BP (PRE) 50 35% BP (STAGE I) 21 15% BP (STAGE II) 4 3% BLOOD GLUCOSE (HIGH) 20 14% BMI (>30) OBESE 42 36% BMI (25-29) OVERWEIGHT 39 33% BMI (<25) 36 31% RISK FACTOR PREVALENCE IN A WORKING POPULATION OF MORE THAN 1492 HEALTH CARE PROFESSIONALS: VERY HIGH RISK N=126 (8%) FRAMINGHAM RISK >20% DIABETES, CVD/STROKE CRF. CRISIS INTERVENTION HIGH RISK PREGNANCY MODERATE RISK N=523 (35%) PRESENCE OF 1 OR MORE FR <10%,BP 121/81-139/89, BMI 25-29 NON SMOKER HIGH RISK N=564 (38%) PRESENCE OF 1 OR MORE FR >10%, BP >140/90, CHOL >240, HDL <40, NON-HDL >160, SMOKING, BMI >30, METABOLIC SYNDROME DEPRESSION LOW RISK N=279 (19%) FR <10%, BP <120/80, CHOLESTEROL NORMAL, NON-SMOKER, BMI <25 2012 ANALYSIS SHOWED POSITIVE HEALTH RISK OUTCOMES IN 1020 EMPLOYEES SCREENED AT LEAST 2 TIMES IN THE AREAS OF RISK LEVEL, CHOLESTEROL, PHYSICAL ACTIVITY, HEALTHY EATING, BLOOD PRESSURE AND BMI >30. CHOLESTEROL VALUES OVER 240 DECREASED BY 15%. GREATER THAN 60% OF THE POPULATION IS WITHIN THE OPTIMAL RANGE FOR CHOLESTEROL. HEALTH AND CLINICAL INDICATORS ADDITIONAL HEALTH INFORMATION THAT HELPS DEPICT THE PROFILE OF BERKSHIRE COUNTY INCLUDES: BERKSHIRE COUNTY HAS LOWER THAN STATE AVERAGES FOR CARDIOVASCULAR MORTALITY RATES. THROUGH THE EFFORTS OF OUR CLINICAL CARE AND OUTREACH, THE RATE HAS DECLINED CONSISTENTLY OVER THE LAST TEN YEARS TO CLOSER WITH THE STATE. OUR AGE ADJUSTED SPECIFIC RATE FOR ALL CANCER DEATHS IS 173.1 WHICH IS LOWER THAN THE STATE RATE OF 177.4 (PER 100,000 PERSONS) FOR SUBSTANCE ABUSE, OUR ADMISSION RATE TO DPH FUNDED TREATMENT PROGRAMS IS 2818.9 VERSUS 1636.5 FOR THE STATE, AND ALCOHOL AND OTHER DRUG RELATED HOSPITAL DISCHARGES IS 995.0 VERSUS 362.0 (PER 100,000 PERSONS) DIABETES MORTALITY EXCEEDS THE STATE RATE 18.86 VERSUS 13.18) WORKFORCE SHORTAGES AND ACCESS TO CARE IN THE LAST DECADE BERKSHIRE COUNTY HAS EXPERIENCED A SHORTAGE OF PHYSICIANS FOR OUR COMMUNITY, AS WELL AS SHORTAGES FOR KEY CLINICAL SPECIALTIES, SUCH AS NURSING, RADIOLOGY AND LABORATORY. THESE SHORTAGES CREATE ACCESS TO CARE ISSUES FOR THE RESIDENTS OF BERKSHIRE COUNTY. IN THE LAST 5-8 YEARS, BMC HAS EDUCATED AND TRAINED HUNDREDS OF STAFF IN ITS CRITICAL SHORTAGE PROGRAMS AS WELL AS HELPED RECRUIT APPROXIMATELY 150 PHYSICIANS TO THE COMMUNITY, REDUCING THE COUNTY'S EXISTING SHORTAGE OF PROVIDERS BY 40 FTES. GIVEN NATIONAL SHORTAGES, INCREASED DEMAND, AND OUR RURAL LOCATION, BMC EXPECTS THAT THIS CHALLENGE OF HAVING AN ADEQUATE NUMBER OF HEALTH CARE PROFESSIONAL TO MEET THE COMMUNITY NEED WILL CONTINUE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.